Digestive Diseases and Sciences

, Volume 53, Issue 5, pp 1375–1382 | Cite as

The Prevalence and Risk Factors for Abnormal Liver Enzymes in HIV-Positive Patients without Hepatitis B or C Coinfections

  • Richard K. Sterling
  • Steven Chiu
  • Kenny Snider
  • Daniel Nixon
Original Paper


Background Abnormal liver enzymes (LFTs) are frequently seen in HIV patients. Because HCV and HBV overshadow other possible variables, little is known about the prevalence and predictive factors of abnormal LFTs in the absence of viral hepatitis. Aims To determine the prevalence and factors associated with abnormal LFTs defined as >1.25 ULN. Methods A retrospective analysis of HIV clinic patients was performed. Variables were determined at the time of abnormal LFTs or by history and included diabetes mellitus (DM), hypertension (HTN), dyslipidemia, HCV and HBV status, metabolic syndrome (MS), and HAART use (NRTI, NNRTI, and PI). Results Patients without HCV/HBV (n = 679/1,208) were younger, Caucasian, had a BMI >30 and had dyslipidemia. The prevalences of elevated LFTs in those without HCV/HBV were AST 20%, ALT 15%, and ALP 43% compared to 64%, 46%, and 63% in those with HCV (all P < 0.0001), and 98% were mild-moderate (grade 1–2). While AST was highly correlated with ALT, neither was associated with increased ALP. In those without HCV/HBV, increased AST was associated with HTN, HIV RNA, and absence of PI use; increased ALT was associated with HTN, HIV RNA, CD4 < 200, MS, and absence of PI use, while increased ALP was associated with age, BMI, CD4%, DM, and NRTI use. Conclusions Mild-moderate increased liver enzymes are common in HIV patients without HCV/HBV and absence of PI use is independently associated with elevations in both AST and ALT, while features typical of hepatic steatosis (DM and BMI) are only associated with increased ALP.


Abnormal liver enzymes HIV infection 



Liver function tests


Human immunodeficiency virus


Hepatitis C virus


Hepatitis B virus


Upper limits of normal


Diabetes mellitus


Insulin resistance




Metabolic syndrome


Highly active antiretroviral therapy


Nucleoside/tide reverse transcriptase inhibitor


Non-nucleoside reverse transcriptase inhibitor


Protease inhibitor


Ribonucleic acid


Body mass index


Aspartate aminotransferase


Alanine aminotransferase


Alkaline phosphatase


Multivariate logistic regression































This work was supported by a grant to RKS (K23 DK064578).


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Richard K. Sterling
    • 1
    • 4
  • Steven Chiu
    • 2
  • Kenny Snider
    • 3
  • Daniel Nixon
    • 4
  1. 1.Division of Gastroenterology, Hepatology, and NutritionVirginia Commonwealth University Medical CenterRichmondUSA
  2. 2.Virginia Commonwealth University School of MedicineVirginia Commonwealth University Health SystemRichmondUSA
  3. 3.Department of PharmacyVirginia Commonwealth University Health SystemRichmondUSA
  4. 4.Division of Infectious DiseaseVirginia Commonwealth University Health SystemRichmondUSA

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